The future of employment support for people with disabilities

Employment support for people with learning disabilities and mental health issues is at a crossroads finds Mithran Samuel

The three sources of jobs support for disabled people face contrasting futures as spending cuts start to bite, finds Mithran Samuel

(Pictured: Frank Hodgkinson, who gained a job through council support in Stockport – see below)

Employment rates for adults of working age with learning disabilities or mental health problems remain low, figures published this month revealed.

The NHS Information Centre says just 6.4% of adults with learning disabilities known to social services are in paid employment. And a Department of Health survey has found the same applies to only 9.6% of mental health patients using the care programme approach.

Labour introduced specific strategies to improve job opportunities for the groups: Valuing Employment Now (June 2009) for learning disabilities and Work, Recovery and Inclusion (December 2009) for mental health.

It also set up a high-level government target – public service agreement (PSA) 16 – to raise job rates.

The coalition is committed to the goals of both strategies though all PSAs have been abolished. The Department for Work and Pensions says announcements on how progress will be measured in future will be made “in due course”, but the scrapping of PSA 16 has caused concerns.

Huw Davies, chief executive of the British Association for Supported Employment (Base), says: “The worry is that it will take attention away from people with secondary mental health needs and those with learning disabilities.”

The coalition intends to improve support for both groups through Work Choice, the DWP’s new disability employment programme. However, there is concern this will not happen, which would leave clients having to rely on services provided through the NHS or local government that better meet their needs. And although it appears the NHS will enhance employment support in coming years, council provision is at risk of cuts.

What will Work Choice achieve?

Work Choice, set to be launched in October, is designed to help disabled people with complex needs into work.

However, there are concerns that it will not support many social care service users. For instance, it is expected to help 21,500 people in its first year across the UK; but 520,000 people use community-based social care in England.

There are also warnings that its performance-based funding regime will stop providers concentrating on care users as opposed to people with lesser needs.

British Association for Supported Employment chief executive Huw Davies says: “With any outcome-based funding model the temptation for providers is to work with those closest to the labour market.”

Providers will receive 30% of their contract fee based on performance, a higher rate than under Workstep, the supported employment programme that Work Choice replaces. This is designed to ensure that Work Choice leads to higher rates of employment than Workstep.

DWP figures show that 50% of Workstep clients enter supported employment within a year of joining the scheme, with 6% sustaining themselves in unsupported jobs.

Work Choice clients, who will be referred by social services and the NHS as well as by job centres, will receive pre-employment support and help to find jobs, followed by either medium-term (up to two years) or ongoing in-work support.

Work Choice’s annual funding will depend on the forthcoming comprehensive spending review but is expected to be similar to the £78m spent in 2009-10 on Workstep and the two other programmes Work Choice replaces, Work Preparation and the Job Introduction Scheme.

But there are concerns over how the funding will be divided up. Unlike Workstep, where the DWP contracts with 160 separate providers, it will only let 28 contracts for Work Choice. These “prime contractors” will then sub-contract work to specialist employment agencies. This “supply chain” commissioning model has been criticised in the past. A National Audit Office report this year into Pathways to Work – another scheme to help disabled people into work – found that two-thirds of sub-contractors expected to make a loss from Pathways, compared with one-third of prime contractors.

But the DWP remains adamant that Work Choice will help those in greatest need. A spokesperson says: “We want the welfare system to give disabled people who can work the dynamic support they need to get into the jobs market and Work Choice will ensure those facing the biggest barriers receive this help. Prime contractors will work closely with sub-contractors who have the specialist knowledge and expertise needed to get these customers job ready and into work.”

The case for councils to redirect funding

Frank Hodgkinson (pictured above) used day services, alongside other people with learning disabilities, for 36 years. Now, aged 57, he works for 16 hours a week as a warder at Staircase House, a Stockport Council museum. The change is the result of support from Pure Innovations, which is contracted by Stockport Council to provide day care and employment support for local disabled people.

His years in day care had left him deskilled and fearful of the outside world. Pure tackled this by giving him opportunities to carry out community activities as a staging post to finding work. In 2005, he gained a job for a few hours a week filling vending machines at a local college and in 2007 an opening was identified at Staircase House. His employment officer, Gina Hilton, and the museum’s then manager carved out a job based on his skills, with tasks including arranging displays, recycling and helping people find their way around.

Hilton helped train him in the job by breaking it down into separate elements and teaching each intensively. While she was heavily involved initially, he now receives five-monthly reviews from Pure as well as specific support when his performance dips. Hodgkinson says working makes him happy and he enjoys spending his earnings on CDs and holidays. However, there are concerns that councils, who face government cuts of 25% from 2011-15, may slash employment support, because it is discretionary, unlike mainstream social care services.

Pure chief executive Doug Cresswell says: “When you are looking for cuts across social care, employment is an easy target. If you are sitting there as a director of social services deciding what are the areas where I’m going to claw back 25% you look to preserve your statutory functions.”

A spokesperson for Stockport says Pure is not immune from cuts although the council has “a very strong commitment” to the service.

Many councils also currently receive money from the DWP through the Workstep disability employment support programme, but far fewer authorities will be funded through Work Choice, which replaces Workstep in October. This could make it more likely that authorities will cut back on jobs services funded from their own resources.

Cresswell says there is a solution for councils: redirecting some of the £900m they spend a year on day care for working-age adults to supported employment. Pure has calculated that moving Hodgkinson from day care to employment is saving Stockport Council £15,000 a year.

Peter Murphy, co-chair of the Association of Directors of Adult Social Services’ learning disability network, accepts the case for reinvestment but says councils struggle to replicate the economies of scale from providing day care when delivering individualised services like employment support.

The previous government’s Valuing Employment Now strategy, published last June, called for money to be reinvested in supported employment from further education, as well as day care, saying too few courses were helping learning disabled students gain jobs. Cresswell agrees, but says this reinvestment has not happened.

But spokesperson for the Skills Funding Agency, which is responsible for the education of learning disabled people over 25, says they are a “priority” group, and that the agency has a “particular focus” on improving their employability through programmes such as apprenticeships.

Great expectations for NHS support service

There is optimism that NHS-funded employment support for mental health patients will improve in the coming years. Unlike councils, the health service is guaranteed increased funding from 2011-15; and there is evidence that one particular model – individual placement and support (IPS) – improves job and health outcomes.

Under IPS, employment support is integrated with clinical care, with employment specialists working alongside social workers, nurses and psychiatrists. Individuals are helped to get a mainstream job and receive time-unlimited support to sustain them in it.

This contrasts with traditional approaches where people are given training and support in day centres before being helped to find work.

A 2007 study across six European countries, including the UK, found that 55% of people using IPS were in work 18 months after starting the programme compared with 28% of those using traditional services. Just 20% of IPS participants were rehospitalised during the 18 months, compared with 31% of others.

The model was championed last December by a government-commissioned employment review in by Rachel Perkins, formerly director of quality assurance and user experience at South West London and St George’s Mental Health NHS Trust (SWLStG), which has pioneered IPS in the UK.

The Labour government’s accompanying mental health and employment strategy recommended its uptake, while eight other trusts are testing the model as part of charity the Centre for Mental Health’s centres of excellence scheme.

Miles Rinaldi, head of recovery and social inclusion at SWLStG, says: “Over the last year to 18 months there’s been a real surge in interest and trusts are seeing employment as important and that [IPS] is the most effective way.”

He says that while the NHS may traditionally not have seen employment support as its concern, “there are clear health benefits to helping people back to work”. By contrast, he says, DWP employment programmes have not served people with long-term mental health problems well. For instance, just 8% of Workstep clients have mental health problems, though Rinaldi says he cannot predict how Work Choice will work for the client group.

Bob Grove, joint chief executive of the Centre for Mental Health, is expecting the coalition’s forthcoming mental health strategy to prioritise raising employment rates, possibly through a performance indicator, making it in trusts’ interests to invest in IPS.

Rolling it out across the country would cost an estimated £67m a year. The Centre for Mental Health says this could be achieved by reinvesting money currently spent on mental health day and employment services, which received £184m in England in 2007-8.

More information from the Centre for Mental Health

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This article is published in the 26 August issue of Community Care magazine under the heading What price work?

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